Department of Internal Medicine C, Emek Medical Center, Afula, Israel.
Rapaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
PLoS One. 2020 Jun 4;15(6):e0234209. doi: 10.1371/journal.pone.0234209. eCollection 2020.
Iron deficiency anemia (IDA) is associated with decreased appetite. The ghrelin hormone is one of the major regulators of appetite.
To evaluate appetite and ghrelin levels in patients with IDA, and to investigate the change in appetite and ghrelin following intravenous iron therapy.
A total of 56 IDA patients and 51 controls were included in the study. Both appetite and ghrelin were assessed at baseline and following intravenous iron therapy. These were assessed at corresponding time intervals in the control group. Appetite was assessed by the SNAQ score (Simplified Nutritional Appetite Questionnaire) and fasting ghrelin levels were assessed by acylated ghrelin (AG), unacylated ghrelin (UAG) and their respective ratio AG/UAG.
IDA patients had significantly lower SNAQ scores, yet higher AG levels and higher AG/UAG ratios compared to healthy controls; the mean SNAQ scores were 12.56 ± 3.45 and 16.1 ± 2, respectively (P<0.01); the median AG levels were 57.5 pg/ml and 43 pg/ml respectively (P = 0.007); and the median AG/UAG ratios were 0.48 and 0.25 respectively (P = 0.04). On multivariate linear regression analysis, IDA remained independently associated with decreased SNAQ score (β = -0.524, P<0.001) and increased acylated ghrelin (β = 0.289, P = 0.013). After IDA was treated, SNAQ scores increased significantly by a mean of 2 points. AG and AG/UAG ratios decreased significantly by a mean of -18.44 pg/ml and -0.2 respectively. The control group showed no significant change in SNAQ scores or ghrelin at corresponding time intervals.
IDA patients have a reduced appetite and paradoxically elevated ghrelin hormone activity compared to healthy controls. Treating IDA enhances appetite and lowers ghrelin levels. Future studies are needed to explore the mechanism of this paradoxical ghrelin activity.
缺铁性贫血（IDA）与食欲减退有关。胃饥饿素激素是调节食欲的主要激素之一。
评估 IDA 患者的食欲和胃饥饿素水平，并研究静脉补铁治疗后食欲和胃饥饿素的变化。
共纳入 56 例 IDA 患者和 51 例对照。两组均在基线时和静脉补铁治疗后评估食欲和胃饥饿素。对照组在相应时间点进行评估。食欲通过 SNAQ 评分（简化营养食欲问卷）评估，空腹胃饥饿素水平通过酰化胃饥饿素（AG）、非酰化胃饥饿素（UAG）及其各自的比值 AG/UAG 评估。
IDA 患者的 SNAQ 评分明显较低，但 AG 水平较高，AG/UAG 比值较高，与健康对照组相比；平均 SNAQ 评分为 12.56 ± 3.45 和 16.1 ± 2，分别（P<0.01）；中位 AG 水平分别为 57.5 pg/ml 和 43 pg/ml（P = 0.007）；中位 AG/UAG 比值分别为 0.48 和 0.25（P = 0.04）。多元线性回归分析显示，IDA 与 SNAQ 评分降低（β=-0.524，P<0.001）和酰化胃饥饿素增加独立相关（β=0.289，P=0.013）。IDA 治疗后，SNAQ 评分平均增加 2 分。AG 和 AG/UAG 比值分别平均下降-18.44 pg/ml 和-0.2。对照组在相应时间点 SNAQ 评分或胃饥饿素无明显变化。
与健康对照组相比，IDA 患者食欲减退，但胃饥饿素激素活性升高。治疗 IDA 可增强食欲并降低胃饥饿素水平。需要进一步研究来探讨这种矛盾的胃饥饿素活性的机制。
